EHEC recommended: Early neurological therapy

[tetano]

EHEC recommended: Early neurological therapy

Hundreds of people are currently using a hemolytic-uremic syndrome in German hospitals, particularly in the north. Note the neurological disorders. The professional society recommends therefore, neurologists involved early in the therapy.
BERLIN (NES). The current wave of EHEC is special - not only because of the rare pathogen and the size of the outbreak, but also because of the neurological consequences for patients.
The German Society of Neurology (DGN) reported about half of patients with hemolytic-uremic syndrome (HUS), which may suffer from severe and sometimes irreversible neurological disorders.
As alarming call it the two Hamburg neurologist Professor Joachim Roether and Professor Christian Gerloff, that the neurological condition in spite of early plasmapheresis does not improve or even deteriorating.
Gerloff is director of neurology at the University Hospital Hamburg-Eppendorf (UKE), Roether is Chief of Neurology at the Asklepios Clinic Altona. Hamburg, Schleswig-Holstein to the trouble spot of the current wave of EHEC.
Apparently striking is the early appearance of neurological symptoms.
Gerloff, 'You can already develop simultaneously with renal and gastroenterological symptoms. " Crucial features of HUS are bloody diarrhea, hemolysis, and renal dysfunction.


On the neurological symptom complex in HUS the first professional association is one of confusion, reduced vigilance, irritability and delirium. There are also many cases in aphasia and apraxia, and disturbances of the brain stem functions. In severe cases, patients develop myoclonic seizures and sometimes that can lead to coma.
The neurologists suspect the cause of these symptoms in the Shiga toxin 2, the EHEC releases. In addition to the hemolytic effect of the toxin leads to a swelling of the vascular endothelium. As a result, the toxin could also lead to a widening of the intracranial vessels and a disturbance of autoregulation in the kidneys.
Also could play the complement cascade at the neurological deficit involved. Nephrologists suggest that Shiga toxin can activate the cascade, such as by binding to the C3 convertase of the alternative activation pathway.

One therapeutic approach is the monoclonal antibody eculizumab, which inhibits the C5 convertase and therefore interrupts the terminal cascade. Initial success in the current HUS cases were hospital doctors reported already. Whether the drug is a general treatment option, however, so far the doctors can not yet be estimated.
The neurologist and Gerloff R?ther argue, given the severe neurological responses for 'drastic therapeutic measures'. Also, she said eculizumab should be considered in each case. UKE on 30 patients treated so far are just that, at the Asklepios Clinic in Hamburg-Altona five.
At the first neurological abnormalities to speak both in favor of early anti-shock therapy, such as anti-epileptic levetiracetam. Diagnostic method of choice is the MRI, the findings are more sensitive than CT.


http://www.aerztezeitung.de/news/article/657698/ehec-fruehe-neurologische-therapie-empfohlen.html

 

[tetano]

Re: EHEC recommended: Early neurological therapy

In most cases of kidney damage and dialysis is talk when it comes to episodes of severe EHEC infection. Bigger seems to be a risk of permanent neurological disorders.
No single news item EHEC sounds reassuring in those days. Particularly disturbing are reports that the severe form of intestinal infection, the HU's syndrome, can lead to permanent physical and mental damage. Now it looks like that the dreaded kidney failure will remain through the Shiga-toxins in EHEC bacteria for most patients a transient fear. Thanks hemodialysis and plasma exchange to recover their renal and take back to work. For the brain - in addition to the kidneys, the second main risk of the body - these seem to fall less medical intervention. But perhaps even more slowly, as Joachim Roether, chief of neurology at the Asklepios Clinic in Hamburg, considers it possible. His department currently has 16 patients with hemolytic-uremic syndrome are treated. "The fact is that show half of HUS patients with neurological deficits.
This is a much greater proportion than in previous outbreaks of EHEC. However, I am optimistic that overcome most of those affected and their problems such as confusion, speech and movement disorders. But know we can not at present. "

http://www.focus.de/gesundheit/ratg...s-gehirn-erholt-sich-meistens_aid_634595.html

 

[Treyfish]

Re: EHEC recommended: Early neurological therapy

Sprouts So Far Innocent of E. Coli Outbreak; Bacterium Strikes Brain Oddly

by Kai Kupferschmidt on <ABBR class=published title=" 6 June 2011">6 June 2011, 5:46 PM</ABBR> |

The source of a deadly outbreak of Escherichia coli bacteria in Germany remains elusive as German officials today announced that the first tests of samples from a sprouts farm implicated in the outbreak were negative. The German farm had been shut down yesterday by authorities and the region's health minister had advised people not to eat the vegetables. The confusing turn of events comes less than a week after German officials suggested Spanish cucumbers were the source, only to later backtrack.


Researchers are now analyzing the genome of the bacterium to understand its evolutionary history and possibly identify its source. Closer analysis of the genome might also offer some clues to how the Shiga toxin made by the bacterium is attacking the brain. This toxin normally targets the kidney, triggering the often fatal development of hemolytic-uremic syndrome (HUS). Usually neurological symptoms are seen in only a few percent of HUS cases, but in the current outbreak "about half the patients with HUS are developing neurological symptoms," Christian Gerloff, head of the neurology department at the University Medical Center Hamburg-Eppendorf, told ScienceInsider today.:tiphat:http://news.sciencemag.org/scienceinsider/2011/06/sprouts-so-far-innocent-of-e-col.html?ref=hp

 

[Emily]

Re: EHEC recommended: Early neurological therapy

If there is any chance there is an autoimmune process going on causing the neurological symptoms, I heard that Dr. Josep Dalmau is back in Barcelona:

http://www.medscape.com/viewarticle/731830

Also there is a Dr. Angela Vincent in the UK who is an expert in that field, too. Contact info here:

http://brain.oxfordjournals.org/content/133/6/1655.full

 

[tetano]

Re: EHEC recommended: Early neurological therapy

Greifswald / Bonn - Medical researchers at the University Hospital of Greifswald and Bonn have found clues to the cause of severe progression in patients with EHEC-HU syndrome.
Many things tends to suggest that was next to the toxin Shiga toxin and the formation of autoantibodies responsible for heavy damage, said the transfusion medicine Andreas Greinacher the University Hospital of Greifswald. The autoantibodies caused a rise of a clotting factor, thus the circulation of important areas of the brain and the adrenal glands is limited. They are formed only by some EHEC patients. Now having their first patients were severely ill treated with a special blood purification therapy. 'The first developments in the blood values ​​make us optimistic. "

http://www.owl-online.de/news/tagesthema/heute/iptc-bdt-20110608-175-dpa_30799450.html

 

[tetano]

Re: EHEC recommended: Early neurological therapy

In blood vessels of a number of seriously ill patients are found accumulations
of a protein responsible for clotting. That limit the
blood flow to certain areas of the brain and adrenal glands, which can lead to
complications such as kidney failure, loss of consciousness and seizures.


Presumably the cause is an immune response, which generates EHEC bacteria. The
immune system then makes known that autoantibodies against the
times its own body. In Greifswald have been a four seriously ill
special treatment that these substances from their blood will be filtered. The
first results are promising, the doctors said.


Previously, scientists have determined that EHEC bacteria is a
type adhesive attaches to the intestinal wall and then spreading a toxin. The
is a rare aggressive variant that is also resistant to common
common types of antibiotics. This makes the infection extremely difficult to
combat. The pathogen belongs to the group of E. coli bacteria, which
Most are relatively harmless.

http://www.telegraaf.nl/buitenland/9982850/___EHEC_kan_afweer_ontregelen___.html?p=3,1?sn=buitenland

 

[tetano]

Re: EHEC recommended: Early neurological therapy

Doctors Shaken By Outbreak's Neurological Devastation

The patient at the Hamburg-Eilbek Hospital describes to doctors how she first had diarrhea, and then grew progressively weaker to the point where she could no longer eat and barely make it to the toilet. When blood appeared in her stool, she became terrified. The young woman at the hospital's intensive-care unit in the northern German port city suspects that lettuce was responsible for putting her in this deadly situation. She then breaks out in tears, completely distraught.

Thanks to several dialysis procedures, she will most likely survive her case of hemolytic-uremic syndrome (HUS), a particularly aggressive complication related to the enterohaemorrhagic E. coli, or EHEC, that has appeared in more than one-quarter of the patients infected by the bacteria. So far, around 2,800 people have been infected in the dramatic outbreak of this rare strain of E. Coli, with at least 722 contracting HUS and 29 dead so far in Germany and elsewhere in Europe. The number of new cases has diminished this week, but the outbreak has left doctors pondering serious questions about the new epidemic.

Rolf Stahl, a nephrologist at Hamburg's University Clinic Hamburg-Eppendorf, explains that, "Neurologists are being confronted with a totally new disease pattern." Never before has an EHEC germ been as aggressive -- and many consider this to be a new epidemic.

And although the majority will survive, some patients will have lasting and serious health problems. "A considerable number of the patients will permanently lose their kidney function and will be dependent on dialysis for the rest of their lives," says Stahl.

At Hamburg-Eilbek, the female patient's kidneys are faring far better, improving with each day that passes. However, a new problem has arisen: She is unable to completely raise her right arm. Eating with a spoon and writing have become difficult for her, and no one knows what will happen next.

Daniel Wertheimer, the physician-in-chief at the Center for Neurology and Neurological Early Rehabilitation at the Schön Clinic in Hamburg's Eilbek neighborhood, says that even something as seemingly mundane as the way she handles a spoon must be closely monitored. The young woman's conspicuous emotional distress also needs to be observed, he adds, because it could be a subtle precursor of much more serious neurological complications of the EHEC infection. They are the most uncanny concomitant feature of this E. coli outbreak.

..

But why is this happening? Does the EHEC pathogen migrate all the way into the brain? No, says Wertheimer, it's more complicated than that. The E. coli strain involved, O104:H4, produces the Shiga toxin. The toxin itself isn't the only problem, however. The body's immunological response to the Shiga toxin causes the walls of all blood vessels, including those in the brain, to become inflamed and swollen. The blood vessels can be likened to pipes with an inside lining that becomes thicker and thicker, until they eventually become clogged. When that happens, parts of the brain are no longer supplied with blood and, in the worse case, can be irreversibly damaged.

..

http://www.spiegel.de/international/germany/0,1518,767569,00.html